Day 1 was a great success overall. The learners were very well engaged and seemed to enjoy the day. There was much discussion in the workshops about how to best support mothers and babies here in Murambinda.
We’re ready for the off. We are expecting 24 learners – nurses, midwives and doctors – on the course starting tomorrow and 24 more for course 2. It’s a privilege to be here and we are looking forward to sharing our skills this week.
We’ve spent the day today going through the whole course and making sure we have all the equipment in order. We are being very well looked after at the hospital’s guesthouse. After dinner this evening, Grace was going over her lectures and Alison – what is Alison doing?
A multi national faculty from Cameroon, UK and Uganda has arrived at Murambinda Queen of Peace Mission Hospital ready to teach two Neonatal Care Courses and identify 12 suitable people to train as instructors later in the year.
Queen of Peace Murambinda Mission Hospital (QPMMH) was founded and established in 1968 by the Sisters of the Little Company of Mary (LCM), under the auspices of the Roman Catholic Diocese of Harare. The hospital operates under the Ministry of Health and Child Care as a state-aided church-related institution. It is the acting government district hospital for Buhera District, and has 125 beds and around 86 staff.
We are delighted and honoured to have been invited to pump prime neonatal training in Murambinda Mission Hospital, Zimbabwe. Teaching equipment is all packed up, printing and laminated completed, visas and malaria pills procured; ready for the off! 5 international instructors are travelling to Zimbabwe from Cameroon, Uganda and UK to teach the first 2 NCCs with a view to facilitating the first instructor training course at the end of 2026. Funding for the programme is from Friends of Murambinda (About us – Friends of Murambinda Hospital UK Charity 1073978), a small charity run by previous volunteers at the hospital.
Zimbabwe’s neonatal mortality rate figures range from 22 per 1000 live births to 30, depending on the information source. Interestingly, the proportion of deaths attributed to premature birth is higher in Zimbabwe than the world averages and those caused by sepsis therefore make up a smaller proportion. In reality, many preterm births are caused by infection so there is inevitably a bit of crossover in the classification. Fortunately, the Neonatal Care Course contains a lot of material about keeping preterm babies warm and feeding them as well as revamped sessions on recognition and management of sepsis.
Feedback forms were received from 51 learners in all. 4 were nurses, 47 were medical officers (mainly doctors with an MBBS degree). Many of the medical officers had been qualified for over 10 years, one or two had been doctors for over 10 years but had only been caring for babies for the past 1 or 2 years. All 4 nurses are regularly working with birth attendants and attending deliveries. They were research nurses employed by CEL to support the birth attendants. They were not confident in resuscitation skills before the course but learnt quickly with the keenness of people who know they really need the skills. The increase in confidence levels is shown in the diagrams below. Confidence in all areas increased by the end of the course but there were more people scoring 3 out of 4 in all areas pre-course than we usually have, perhaps because of the overall higher level of training of these learners.
Free text feedback comments were all positive from the enjoyment of the course point of view and the perceived usefulness of the skills taught. Most of them had not been taught before using simulation techniques and this aspect of the course was much appreciated.
Interestingly, confidence in supporting a mother to breastfeed was quite high before the course but the questions on breastfeeding in the MCQ exam scored the lowest overall. This mismatch might be worth looking into – is breastfeeding generally thought of as a good thing but people are not so sure of how to help the mother with the practicalities of feeding?
A UNICEF report from 2024 states: breastfeeding is one of the most critical behaviours for child survival and growth. The NFHS-5 (2019-21) shows very low rates of early initiation of breastfeeding (EIBF) within an hour of birth for Uttar Pradesh at 24 per cent.
Key Breastfeeding Data (NFHS-5, 2019-21):
Factors Affecting Rates:
Healthcare Practices: Lack of training for staff in some facilities hinders immediate, “skin-to-skin” contact.
C-Section Deliveries: A major factor causing delays in early initiation.
Social and Cultural Beliefs: Rituals such as delaying feeding until after a bath or discarding colostrum remain prevalent.
It’s a complicated simulation with some challenging moments – as in real life. By the end of the afternoon, the medical officers we were teaching were so much better at running this simulated situation which is more familiar to them in Varanasi unfortunately than we see in the UK. Questions like “when do we stop resuscitating if the heart rate is still not audible and we’ve given 2 rounds of adrenaline?” and “what do we do when the baby is still fitting after glucose and 3 anticonvulsants?” led to long reflective discussions with – I hope – some sort of therapeutic tinge to them. These medical officers are called to the baby when all is not well at delivery, and often they are too late to help the baby. It was uncomfortable for some of them to think about cases they had been involved in. By the end of the course a few of them had some good ideas about how to better support and train the birth attendants and the importance of multidisciplinary team working in an emergency.
Our learners on both courses have been medical officers, mainly medical graduates with some homeopathy graduates and those from an Ayurvedic background (Ayurvedic Medicine: In Depth | NCCIH). We have had over 30 learners on each course with a wonderful sense of engagement with particularly the simulation aspect of it.
The densely populated Uttar Pradesh (UP) state in India is the size of France and has a massive population of over 240 million. Still, it’s toll of around 170,000 newborn deaths each year (around 28 deaths per 1000 live births) is quite shocking. 40% of neonatal deaths occur during delivery or within the first 24 hours after birth. The Community Empowerment Lab believes that 70% of these could be prevented with simple interventions without the need for intensive clinical care and they have done a huge amount of work on trying to prevent neonatal deaths.
The leading causes of newborn deaths include premature birth (35%), neonatal infections (33%), birth asphyxia (20%) and congenital malformations (9%). [https://www.drishtiias.com/state-pcs-current-affairs/child-mortality-rate-in-uttar-pradesh]
One of these simple interventions is Skin-to-skin care, also called Kangaroo Mother Care (KMC). CEL’s research on the state’s KMC programme has shown fantastic results:
We went to the neonatal unit of the hospital we are teaching in to see KMC in action:
A few photos from day 1 of our 2 courses in Varanasi where we are teaching in collaboration with the Community Empowerment Lab, a not-for-profit community entrenched global health research and innovation organisation based in Lucknow.
31 medical officers from across Varanasi have turned up for a 24 person course. Teaching groups of up to 8 is challenging but we’re loving the enthusiasm.
